I noticed the other day that the two posts I have written on duragesic patches and their generic equivalents are still the most viewed and commented upon posts in hospice blog history. (The original posts are here and here.) While reviewing the posts and comments I thought it was time to reveal what time has taught me.
The reason that these posts have gotten attention is that there were a lot of negative claims being made about the new generic versions of these pain patches. The patches are high powered and long lasting, so there are countless people who depend on them to control their severe chronic pain. If they don't work, a lot of people will be in a lot of pain. It is a serious subject. You can read the posts, so I won't rehash the claims being made.
With a year behind us, I can tell you what I have found. We have had no problems at all with the generic patches. Zero. Actually, that's not true. We had one patient who was allergic to the adhesive that kept the patches on. Don't know if he would have been allergic to the adhesive on the name brand patches or not; he didn't live long enough for us to find out. From what I've seen, the hoopla was just that - hoopla.
We have used the Sandoz patches exclusively, and while reviewing the comments, most of the people complaining where complaining about the other type of generic. I have never stuck one of those on one of our patients, so I can make no claims for or against those patches. Our research showed that the Sandoz patches were the exact same as the brand name. My experience has shown that to be true. Obviously, this isn't scientific work here, but I just thought I should report what my hospice has experience over the past year. We've used a lot of the Sandoz patches, and they have worked exactly like they are supposed to. I hope this helps others who are still trying to figure out what is fact and what is fiction.
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21 comments:
Interesting....
I use a small dose fentanyl patch to help control my chronic pain. I've been on it since December, and it's been a godsend. I use the Mylan brand, which I really like: they're smaller, for one, which as a nursing student striving for discretion is handy.
My pharmacy gave my the Sandoz brand one month, and I definately noticed a difference (and I hadn't heard of any "hoopla" before, either, so I wasn't expecting it). All of a sudden, my pain was out of control. The design of that brand seems like the medication may not contact the skin as well as it does with the Mylan brand. In addition, the adhesive on them gave me a rash. When I called the pharmacy, they said that my call wasn't the first one they'd gotten about poor pain control from the sandoz vs. mylan patch, and were willing to take back the patches I had and order me the Mylan ones. As soon as I got my old brand back on, the pain was back under control and I was fine again.
Interesting thing, that. Wouldn't think it would make a difference, but I won't use the Sandoz ones for myself.
(anon for now, sorry--discretion calls)
Interesting observation.
The Sandoz patch is manufactured by the same company that manufactures the "brand name" fentanyl patch. Basically the difference between Sandoz and brand is a peel off label and a box.
Regards,
Bugtustlebub
(compounding -only pharmacy)
Hi. Have been a Hospice Nurse for 13 years at a Not For Profit in Upstate NY.I believe Bugtustlebob is incorrect in the assertion that generic Fentanyl patches are made by the same manufacturer as the Brand Name...former is Sandoz, latter is Janssen. I too have encountered both uneven pain control and adhesive allergies w/ the generic variety, but did not know there are two alternatives on the market. Am going to bring this post and comments to the attention of our medical director.
Thanks
Hi - glad to find this blog and look forward to hearing from other hospice co-workers around the country.
I started with the Mylan patches last July. 75 mcg. 72 hrs. did nothing. Next month, was upped to 150 mcg./48 hrs. I really wanted it to work and I guess it helped. I figured I didn't know any difference between the other kind and this one so, how it worked was all that mattered. I finally asked to switch to the Sandoz. Bingo. Big Huge Difference. I'm happy and healthy and doing fine. I wish I didn't need these but for now I do. I can't imagine the difference in terms of FDA requirements. I believe it has to do with how our individual systems metabolize the meds and from my own experience, the Mylan delivery system was very uneven. I would hate to think what might happen if I had to switch back to those.
I had been on the Duragesic patch when it suddenly stopped working in the middle of the night. I had put on a new patch that morning. I started serious withdrawal symptoms. I decided the patch was faulty and put on my last Duragesic patch. Twelve hours later, withdrawel again. I then tried the generic patch which I had just gotten a prescription for. Same thing. My partner was out of town, my doctor and nurse were out of town. I started making phone calls. Everyone said to do what I had to until my PCP returned. And, definitely not try to withdraw on my own. My doctor returned, decided I was abusing the med and told me to titrate down which I did. She also fired me as a patient without me having another doctor in place. The end result was I had severe restless leg syndrome and seizures. Jim called 911. In the ambulance, I stopped breathing. All sorts of things were done to revive me. I spent time in IC and then in a nursing home. My former PCP did give me a script for Morphine ER and Oxycodone when I left the nursing home but after that, no more. I still have mild withdrawal symptoms daily. When I am out of the meds she gave me it will be cold turkey time again. I do have an appointment with a pain clinic before they run out.
I got thru the whole thing by chewing small pieces of the generic patch to stop the withdrawal symptoms. I did not tell her this until after I got out of the nursing home. She had already "fired" me and I wanted to give her the entire story.
Has anyone else had the experience of having the patch suddenly stop working? I never abused drugs before either script or street.
CaraLea
I had been on the Duragesic patch when it suddenly stopped working in the middle of the night. I had put on a new patch that morning. I started serious withdrawal symptoms. I decided the patch was faulty and put on my last Duragesic patch. Twelve hours later, withdrawel again. I then tried the generic patch which I had just gotten a prescription for. Same thing. My partner was out of town, my doctor and nurse were out of town. I started making phone calls. Everyone said to do what I had to until my PCP returned. And, definitely not try to withdraw on my own. My doctor returned, decided I was abusing the med and told me to titrate down which I did. She also fired me as a patient without me having another doctor in place. The end result was I had severe restless leg syndrome and seizures. Jim called 911. In the ambulance, I stopped breathing. All sorts of things were done to revive me. I spent time in IC and then in a nursing home. My former PCP did give me a script for Morphine ER and Oxycodone when I left the nursing home but after that, no more. I still have mild withdrawal symptoms daily. When I am out of the meds she gave me it will be cold turkey time again. I do have an appointment with a pain clinic before they run out.
I got thru the whole thing by chewing small pieces of the generic patch to stop the withdrawal symptoms. I did not tell her this until after I got out of the nursing home. She had already "fired" me and I wanted to give her the entire story.
Has anyone else had the experience of having the patch suddenly stop working? I never abused drugs before either script or street.
no doubt.....all three ofthe major brands of the fentanyl patch have about the same side affects for different people...and yes...they can just stop working before they are suppossed to...here is something to concider though...even if you dont feel it, the fentanyl may still be entering your body.....never put on more than one patch at a time...if it dosent kill you, it will bring your tollerance up so high that no one patch will ever relieve your pain again.
Pain Sufferer,
I have been on the sandoz brand for over 8 mo.'s, and had problems with the patches staying stuck on my skin and getting a rash from the adhesive. The pain clinic said to try something to keep the rashes from forming by spraying on nazonex allergy spray before applying the patch to that site. After it dried apply the patch. I thought they were jokeing but gave me a script for it and it actually helps a lot. The rash is 90% better than before. Also wrote a script for a product called OPSITE dressing to go over the patch and help stay stuck. I did not try as they were expensive 10 patches for $25, but I did use band-aide brand waterproof band-aides with pretty good success. Now I think it is time to up the doseage or try the Duragesic brand as the effectiveness of this size (25mcg) is not working as well and I am having to take more break through meds. lately. Thank GOD that I found this pain clinic, they have been wonderfull at treating my chronic pain (compression fractures in 3 vertibrae) from a motorcycle acc. more than 5 years ago. All the other DR's did not want to give me the meds that make my life for me and my family normal again. It's too bad that there is so much abuse of this much needed pain medicine that it keeps Dr's from prescribing it to people that really need it to have quality of life, and make the patients go through so many hoops and dr's making you feel like a drug addict, on top of the agony that you are already in. Thank you all for all the great info. P.S. my Pharmacy is now telling me that they are only going to be able to get the mylan brand generic from now on, guess I will find a new pharmacy or try to get on the Duragesic brand, since all of the negative feed on the Mylan Brand.
I also tryed the Mylan patches first and the Sandoz seems to work better but sometimes the patch distributes way too much medication and at other time it's like I'm not getting anything. Any suggestions, anyone?
Interesting, over the past few weeks, I've had some trouble myself. I've been on these patches for YEARS....and because of tolerance, my doctor just moved me up to the 100mcg/hr patch. I always put a new patch on in the morning, and like clockwork, 48 hours after putting on the new patch, I wake up, drenched with sweat, in severe pain, shivering....in short, going through complete withdrawal. This is the 100 mcg patch- and before, I was using the 75, and this did NOT happen. And the longer I try to wait before putting on a new one, the less time the new one lasts. I am also not a drug addict, but I AM afraid to tell my doctor, although he has been super understanding thus far. I even checked the expiration date on the boxes to make sure the patches weren't past their prime- nothing. I'm extremely confused, and scared.
my mother has been using the sandoz patch.. After returning numerous patches to the pharmacy because the patch was dry and did not have the gel appearence they have decided that i was tampering with them.Never had a problem with dry patches when she was using duragesic. Has anyone else gotten dry patches. Hers were 100mcg
I use the Sandoz brand 50 mcg patch, change it every 48 hours, and notice that quite often, after applying a new patch, I will have the sweats and chills of withdrawal, off and on for 2 days, until I apply a new patch. I don't know if it has to do with activity level, fluid intake and/or retention, or if it's the patches themselves, but it's very obvious to me that some of the patches work better than others. No one seems to know why.
Are these patches still useful after the expiration date? I have a new script for the 100mcg/hr patches but found some that expired a few months ago. Can I use those before paying for the new ones? My money situation is very tight because of my pain and if I can use the expired ones (Feb 2007) it would be great.
I have been on duragesic patches brand name for 1.5 years.So expencive.After insurance pays for it i still have to pay $198 for 5 patches it's ridiculous.At Xmas i couldn't get a hold of my dr to get a script cause i was running out so i went and got a script from a different dr and the pharmacy called my dr later and told him that i was getting these from 2 different dr's so he fired me and called the other dr so he wouldn't give me any.Now i'm running out i have last patch on and should start feeling horrible by tomorrow,my heart is already beating fast today so i took valium.What should i expect with withdawals?I forgot to say i was also using vicodin or lortab 10/500 at the same time.How dangerous is it ifi just go cold turkey?I'm 28
I have been using a fentanyl patch for 4 years to treat chronic pain due to degenerative mandibular joint disease. Over time that time I have tried several different brand name patches and a couple different generic brands all at 75 mcg/48 hours. After much trial and error I have found the Mylan brand generic patch works very well for me. I think the smaller size is great and the plastic matrix delivery system which can't leak, thus avoiding possible overdose, is a big bonus. I've figured out that I go through withdrawl for different reasons depending on what's going on with me at the time. Stress, both physical and mental, is a big factor. Not getting my patch changed exactly on time is another biggie. Hormone changes, changes in patch placement location, did I say stress?, accidental patch loss (like it gets pulled off by my clothing and I don't know) and changes in routine all can contribute to withdrawl symptoms forming. When I was using the pillow patch delivery system sometimes it would leak and I wouldn't know until it was too late and withdrawls had already started. One idea to deal with withdrawl is perhaps to find a breakthrough medication to take when the withdrawl symptoms have begun. I have tried Oxycodone, Percocet, Methadone, Morphine and Vicodin as breakthrough medications. I've tried going cold turkey a couple times, never with any success. The withdrawl symptoms became absolutley unbearable. I ended up talking to my doctor about weaning off slowly. If you can, talk with your physician. If you don't go through a doctor, there are a couple webs sites dedicated to weaning yourself off opoid medications. Going cold turkey is VERY difficult and dangerous, so be prepared for a fight. Just as we as people are all diffferent, everyone who uses the patch may react differently (brand name or generic, pillow or matrix). For me the Mylan patch controls my pain enough to allow me to work and raise my kids. I've decided the few various side effects (mostly occassional withdrawl sysmptoms) are a part of the bargain. Each company brand and/or generic patch is different so keep researching and trying new options. There's a patch out there that will manage your pain, work for your body and your lifestyle.
Dear Anonymous, Your Doctor was right, you are probably abusing them. I believe that your idea of "the patch suddenly stop working" was actually the fact that tolerance has caught up with you and you don't feel really good anymore. Are you sure the "pain management center" isnt a Methadone Clinic? I used to call them that...it doesnt make them sound as bad huh? You should talk to someone at the "pain management center" about some suboxone. Anything else will keep you an addict. And whoever said cold turkey is "very difficult and dangerous" is full of it. Alcohol withdraw...maybe dangerous, but opiates--unless its methadone or something else as nasty--then youre fine. Get some benadryl and some tylenol. Take a lot of showers and shut-up!
Am on day 2 of "white knuckling" it. I've been on these patches for many years & am just tired of the race, tired of being tired, memory loss, having to scramble to make sure you have enough patches, count days on the calendar. It takes up too much of life. I'm going to try to live with the pain for a while. I'm taking valium to try to sleep & relax my way thru the best I can but it's so hard already. I hope I can make it. I'm laying in a pool of sweat, shaking, muscle aches & spasms, stomach ache. I'm trying this myself as I just don't trust doctors. They don't believe what you say. I'm in this shape because many doctors wouldn't believe I was injured. They though I wanted drugs & my conditiongot worse & now is beyond repair because no doctor believved me until it was too late & the permanent damage was done to my spine. All because I was a young woman I could not have been hurt but looking for drugs. I'd never been to a hosp in my life until then, they just didn't look or care. Now I pay for their indifference, especially tonight. Pray for me & hope with me that I get thru this on my own. I have children & I can't leave or draw attention to this. I have to do this by myself. Thanks, S
To those of you who are suffering due to this med I can't tell you how much I feel for you and am right there with you!!
To those of you who are ignorant, please take note of this as you are willing to criticize and judge others for things out of their control. People who take just about any med WILL, not can, but WILL experience dependency. This includes Paxil, Motrin, Tylonel ETC... No one needs judgement while they go through this process, and if your life is so messed up you feel that it's your right to judge others I feel extremely sorry for you! People, like myself, start out in severe pain and docs give us short-lived pain meds. Those don't work after a while so we go up up up, until what we thought was a god send is really a reality in hell.
I want to thank the one individual on this site who likes to judge and tells others to take a shower and shut-up! That person is obviously not as intelligent as they'd like everyone to believe or they'd mind their own or maybe just maybe, try and say something helpful.
Do me a favor, and don't ever take your aggression out on anyone again who is looking for a bit of empathy.
I just started using it today - 25 mg Mylan - how long until I feel anything - either pain relief or any side effects?
Answer to the question: "I just started using it today - 25 mg Mylan - how long until I feel anything - either pain relief or any side effects?"
With another generic Duragesic, our experience was it took about 8 hours before the first patch took effect in terms of pain relief. We used a milder pain medication in the interim. There should be information about your generic on the Web that relates to your question.
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